Background <p>Despite a significant reduction in the burden of malaria in the last decades, the disease remains a significant global public health threat. Community perception, knowledge, and practices are key determinants in malaria transmission. Mudzi is a border district in Zimbabwe, characterized by persistent malaria transmission despite having high indoor residual spraying coverages that meet the World Health Organization (WHO) indoor residual spraying (IRS) coverage thresholds. Human socio-economic behavioural factors driving persistent transmission have not been documented.</p> Methods <p>A mixed-methods cross-sectional study was conducted to establish knowledge, practices, and perceptions among Artisanal Gold Miners (AGMs) and Community members (CMs). Two active artisanal mining sites and catchment villages were purposively selected for this study.</p> <p>Malaria RDT test kits and blood slide examinations by microscopy were used to establish malaria parasitaemia prevalence. Data were collected via Kobo Collect and analysed using Microsoft Excel to generate frequencies and analyse for statistical differences.</p> Results <p>A total of 128 AGMs and 113 CMs were recruited. 277 individuals were tested for malaria using RDT and blood smear microscopy. Responses showed good knowledge of the cause and transmission of malaria. However, low risk perception and misconception among AGMs and CMs were observed. There was no significant difference concerning education, knowledge, and perceptions between AGMs and CMs. AGM predominantly lived in the open without protective measures for long periods. Community members and artisanal miners (AGMS) showed high preferences and utilisation of standard care offered through health facilities and community health workers (CHW). The majority of AGMs and CMs received health education from HCWs. Malaria prevalence across the groups was less than 1%.</p> Conclusion <p>High knowledge of malaria is not translating into preventative behaviour and high-risk perception among AGMs and CMs. There is a need to create innovative health education interventions that motivate individuals to increase risk perception and behaviour modification. Communities are likely to prioritize survival over malaria avoidance practices, therefore, an integrated intervention that addresses livelihoods and malaria prevention needs to be developed.</p>