While precautionary efforts are being made to minimize human health problems associated with agricultural pesticides, the continued occurrence of occupational poisoning from these chemicals raises major concerns among stakeholders. Information gap on human health problems associated with pesticides poses major obstacles to making informed policy decisions, particularly in developing countries where most of the poisonings occurs. In this study, we identified acute human health symptoms associated with pesticide use in cotton zone of Côte d’Ivoire and, documented the response of rural households to the symptoms. The results show that cotton farmers in Cote d’Ivoire suffer from different occupational health hazards from exposure to agricultural pesticides. Key health symptoms reported by pesticide applicators are headache, rheum, cough, skin rash and sneezing. Pesticide applicators reported four times higher symptoms of ill health than other household members who do not normally handle pesticides. Although, households recognized pesticides as an important cause of ill health, some of the symptoms have been accepted as norm by individuals who apply pesticides. Official data on pesticide poisoning in the country is most likely to be seriously under-estimated as applicators visited formal health centers for medical assistance in only 2% of poisoning cases reported. There is a high likelihood that households in the study area under-estimated pesticide-related health costs in making farm production decision-making. Approaches to use economic instruments for reliable monitoring and reporting procedures to formulate appropriate policies and regulations to minimize exposure to pesticides are recommended. Health planners and policy makers should aim at reducing the risks posed by pesticide to farm households by, improving awareness of farmers; promote complementary approach (e.g. Integrated Pest Management) and, use of economic instruments and improved surveillance to bridge the gap in the documentation of pesticide poisoning cases among farmers.