Food safety and nutrition insecurity remain pressing challenges in coastal communities, where inadequate infrastructure and unsafe food-handling practices compromise household health. This study assessed food safety and sustainable consumption patterns using data from 360 households collected through structured questionnaires. Descriptive statistics and ordered probit regressions examined socioeconomic characteristics, knowledge, attitudes, and practices (KAP), as well as dietary outcomes. Despite moderate Household Dietary Diversity Scores (HDDS) and Food Consumption Scores (FCS), diets were dominated by cereals, legumes, roots/tubers, and fish, with limited intake of fruits, eggs, and dairy. About half of households relied on refrigeration for food preservation, yet many continued to use less safe methods such as smoking, sun-drying, or open-shelf storage. The main food-safety risks were contaminated water (40.6%), inadequate hygiene (26.4%), and insufficient storage (21.1%), reflecting a persistent “I know, but I cannot” dynamic: households are aware of safe practices but constrained by resources, time pressures, and infrastructural deficits. Socio-demographic factors including household size, gender, age, education, occupation, and widow/widower status—interacted with structural and economic constraints to shape dietary diversity and food-safety behaviors. Widow and widower households were particularly vulnerable due to reduced labor capacity, income instability, and higher care burdens, highlighting the need for targeted policy interventions such as social protection programs, subsidies for hygiene and storage resources, and community-level water and cold-chain infrastructure. The research, therefore, recommends practical, low-cost, health-motivated strategies that leverage awareness of health benefits promoting affordable, micronutrient-rich foods, reinforcing hygiene routines, and ensuring safe preservation to improve both dietary quality and household food safety in resource-constrained coastal settings.