This cross-sectional study was conducted to determine the prevalence and associated risk factors of bovine tuberculosis (bTB) among large ruminants of the five districts (Peshawar, Nowshera, Charsadda, Mardan and Swabi) located in the central zone of Khyber Pakhtunkhwa (KPK), Pakistan. A total of 2400 large ruminants were sampled by convenience sampling approach and tested by comparative cervical intradermal tuberculin test (CCIT) for detection of Mycobacterium bovis infection. Data regarding socio-demographic status, risk factors and farming practices were gathered through a pre-form questionnaire. Results revealed that prevalence of bovine tuberculosis was 5.88%. Statistical analysis revealed significant association of age (OR= 3.267; CI = 1.686-6.331) and herd size (OR = 2.600; CI = 1.421-4.760) with CCIT positivity. Similarly, induction of new animals into the herd (OR= 2.661; CI = 1.758-4.028) and sheltering the animals at night (OR= 2.448; CI = 1.568-3.882) also showed association with a positive skin test. The herd owners and animal handlers had poor knowledge regarding signs, symptoms and the zoonotic nature of the infection. Three primary signs (persistent cough, weight loss and fever) were recognized by 4.7% of respondents including herd owners, herders and animal handlers. This study calls for instant measures for disease control among the animals and humans of the study area, and highlight the need for farmer education regarding bovine tuberculosis.