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Exposure to pesticides has been reported to cause adverse health effects, and great numbers of people have been affected globally. Annual severe pesticide poisoning cases amount to 3 million worldwide; 25 million symptomatic occupational pesticide poisonings occur each year among agricultural workers in developing countries. Increased health symptoms have been reported as a result of pesticide exposure. In Tanzania there is limited information on health symptoms associated with pesticides exposure among horticultural pesticide applicators.A cross-sectional study was conducted among 140 pesticide applicators working in horticultural farms in three districts of Arusha region. Data on demograph, types of pesticides used, spray duration, use of personal protection equipment and neurological symptoms were collected by using a structured questionnaire. To determine the intensity of pesticide exposure, acetylcholinesterase assay was done by using the Test-mate Model 400 device with a photometric sensor. Data were analysed by using SPSS version 20.0.The pesticide applicators were men with mean age 29.59±6.789 years and mean work duration of 5.76±3.036 years. Organophosphate pesticides were commonly used by 95% of the pesticide applicators. Sixty percent of pesticide applicators reported to use personal protection equipment during pesticide application. The neurological symptoms reported were body weakness, perspiration, headache, painful part of the body, poor appetite, depression and irritation. The mean average of acetylcholinesterase was 26.788±4.0952 u/g hgb. About 27% of pesticide applicators had acetylcholinesterase level below the limit value of 24.5 u/g hgb.The study shows 27.1% of pesticide applicators had acetylcholinesterase level below the limit value suggesting that exposure to pesticide may result to the neurological symptoms reported. Therefore specific pesticide management interventions are needed to prevent pesticide exposure and reduce the incidence of neurological health symptoms among the pesticide applicators. Acetylcholinesterase monitoring is needed for horticultural farm workers’ surveillance.