Background: Preconception care is one of the preventive strategies in maternal and new-born health as recommended by WHO. However, in sub-Saharan Africa there is poor preconception care practices. This study examined knowledge and perceptions of preconception care among health workers and women of reproductive age group in Mzuzu city, Malawi. Methods: A descriptive cross-sectional mixed methods approach utilizing quantitative and qualitative methods was employed. Selection of respondents was done through a multistage and purposive sampling techniques. A total of 253 women of reproductive age from 9 townships of Mzuzu City responded to the questionnaire and 20 health workers were interviewed.Results: Of the 253 women, 57.7% (n =146) demonstrated a good level of knowledge of preconception care while 42.3 % (n =107) had poor knowledge level. About 72% (n =105) of those with good level of knowledge lacked awareness on possibilities of talking to a health care provider on intentions of getting pregnant. About 74.7 % (n =189) of women had a positive perception towards preconception care. Knowledge level of women was a good predictor of positive perception (AOR = 2.5; 95% CI = 1.215 – 5.023), however its prediction capacity varied with the academic level attained. Those with secondary (AOR =10.2; 95% CI = 3.285 - 26.276) and tertiary (AOR=2.3; 95% CI = 1.146 – 4.952) were more likely to have good knowledge than those with primary school level education. About 95% (n =19) of health workers lacked details about preconception care but they admitted their role in preconception care.Conclusion: Preconception care practice among health workers and women of reproductive age in Mzuzu City is low but there is positive perception towards preconception care among both parties. There is an opportunity in existing platforms for implementation of interventions targeting identified predictors for increased knowledge and uptake of preconception care.