Prahoc is a traditional, fermented fish product in Cambodian diets. Fermented products like Prahoc may play a range of beneficial roles nutritionally, culturally, and financially. However, the use of freshwater fish and long-term storage may also pose food safety risks of parasites and microorganisms. We conducted a mixed-methods study of Prahoc to describe the complex risks and benefits of this food that included semi-structured interviews (prahoc-producing households, n=22; small and medium enterprises n=6), production observation, sample collection and analysis of nutrient composition and food safety parameters. Nutrient composition analysis showed that while Prahoc contributes small amounts of zinc, iron, and other key minerals to the diet, it is also very high in sodium (∼101,621 mg kg^-1). Food safety analyses showed that while further tests are needed to resolve Listeria monocytogenes, Salmonella spp., and Vibrio risks, all samples were in compliance with the Cambodia Standards for Prahoc, and there was no evidence of parasites. Participants described Prahoc as playing an essential dietary and cultural role, and also making important contributions to household welfare, particularly within households and businesses that sold Prahoc. Despite the potential risks of microbial food safety and high sodium intake, Prahoc production offers benefits by adding value to fresh fish, reducing loss and waste, and preserving the harvest. However, Prahoc production depends on fish availability and is limited by declining access and high prices. Thus, freshwater fisheries management should take into account Prahoc production activities, an important value chain activity that contributes to the livelihoods of rural Cambodian communities.