Cameroonian farmers regularly use pesticides in farming to control pests, particularly along the riverbank of the Santchou agricultural area. The aim of this study was to assess the perception of farmers in West Cameroon (Santchou area) regarding the contamination risk in aquatic environments from the use of pesticides. A cross-sectional study via questionnaires was conducted among 150 selected farmers who cultivated fields along the banks of the Menoua River. Almost all the farmers (90%) used pesticides regularly, particularly herbicides, insecticides, and fungicides to combat pests. The main pesticides used were glyphosate, paraquat, dieldrin, chlorpyrifos-ethyl, copper oxide, and mancozeb. Farmers who cultivated larger areas of land or who had mixed culture crops tended to use pesticides more often (p < 0.001). The use of river water by farmers was correlated with pesticide use (p = 0.010). Most of the pesticide users (90%) did not use protective equipment when spraying the crops. The farmers' perceptions of the risk of pesticide contamination of the river water (p = 0.002) or fish (p = 0.008) did not influence their actions. A correlation was found among pesticide users who believed that there was a risk of river contamination (45%) or fish contamination (42%) and intensive pesticide application during the rainy season (61%) or non-respect of the prescribed pesticide application doses (51%; p = 0.002). Farmers who regularly or occasionally consumed fish used pesticides more often than those who did not consume fish from the river. The findings of this study emphasize the need for education of farmers in Santchou to prevent the risk of environmental contamination and health hazards from increased dietary and/or dermal pesticide exposure. Integr Environ Assess Manag 2023;19:1600-1608. © 2023 SETAC.