Taenia hydatigena causes taeniasis in dogs and wild canids, with Cysticercus tenuicollis infecting small ruminants. Data on its incidence and risk factors in Pakistan are limited. This research work was carried out to determine the prevalence of C. tenuicollis in sheep and goats across Punjab and Khyber Pakhtunkhwa (KPK). A cross-sectional research study examined 9,273 randomly selected small ruminants from abattoirs in Faisalabad, Lahore, Multan, Bahawalpur, Sialkot, Rawalpindi, and Peshawar. Pre-slaughter and post-mortem investigations identified C. tenuicollis in 552 animals (5.95%). Punjab had a higher prevalence (6.84%) than KPK (3.35%). Faisalabad recorded the highest prevalence (8.14%) with a significant odds ratio of 2.43 (95% CI: 1.80–3.29). Males (6.20%) had a slightly higher infection rate than females (5.47%). Adults (8.08%) were more affected than young animals (4.08%). Irrigated plains (Lahore, Faisalabad, Multan) exhibited an 8.00% prevalence, significantly higher than wet mountainous areas like Peshawar, with an odds ratio of 2.39. These findings suggest C. tenuicollis is prevalent in both provinces with higher rate in Punjab, posing economic losses to the small ruminant industry. Factors such as region, sex, age, and climate influence infection rates. Molecular studies are needed to identify genetic variations and improve control strategies.