Taenia saginata cysticercosis is one of the zoonotic diseases that threaten food safety and food security, particularly in developing countries. A cross-sectional study was conducted to estimate the prevalence and cyst distribution in infected cattle, and food safety implications of Taenia saginata cysticercosis in Harari People’s National Regional State, eastern Ethiopia. Post-mortem inspection of carcasses and organs of slaughtered cattle in Harar Municipal Abattoir, cyst viability tests and interviews with randomly selected meat consumers were undertaken. The post-mortem inspection showed that of the 898 local zebu cattle slaughtered for human consumption and examined for the presence of cysticerci of T. saginata, 19.7% (177/898; 95% CI = 17.2–22.5) harboured at least one cyst in the muscles or organs inspected. Of the edible anatomical sites with cysticerci, shoulder muscle, liver and heart together represented 65.4%, 66.0% and 65.4% respectively of relative prevalence, total cyst count and cyst viability. These edible sites are preferred above others by local people for preparation and consumption of raw or inadequately cooked meat dishes that are locally served as kurt, kitffo and dullet. The interviews revealed that among the 300 study participants, 182 (60.7%) had been infected by taeniosis at least once during the previous year and of these 99.0% had eaten raw or undercooked beef, the majority (88.3%) obtained from butchers assumed to provide officially inspected meat that was fit for consumption. This indicated that existing meat inspection processes were inadequate to prevent carcasses infected with T. saginata cysticerci from reaching consumers. The high prevalence of viable cysts in the edible parts of beef together with the widespread consumption of raw or undercooked beef indicated the importance of T. saginata cysticercosis as a food safety problem in eastern Ethiopia. The promotion of policies to upgrade existing meat inspection procedures and public education to ensure effective prevention of T. saginata taeniosis in humans were recommended.