In an interview study conducted among smallholder rice farmers in Rufiji, Tanzania coastal mainland, and in Cheju, Zanzibar, farmer's pesticide use and risk awareness were assessed. The farmers generally lacked knowledge or possibilities to manage the pesticides as prescribed by the manufacturers. Few farmers knew what kind of pesticides they were using and had never seen the original packages, as pesticides were usually sold per weight or already diluted without labeling. Protective equipment was rarely used since they were not aware of risks associated with pesticides or did not know where to purchase protective gear. Only half of the farmers were aware of pesticides' health hazards and few associated pesticides with environmental problems. The pesticide use was relatively low, but based on farmers' pesticide handling and application practices, health risks were a major concern. Most farmers did not believe in successful rice cultivation without using pesticides to control pests. However, estimated yields did not differ between pesticide users or farmers using conventional methods or neem tree extract. To avoid negative effects on human health and the environment, the farmers need basic education and better assistance in their farming practices and pesticide management.