Objective: To review what we know about urinary schistosomiasis in Lake Malawi and summarize our attempts to use fishes as a biological control of the intermediate hosts.

Conclusions: A One Health approach must be employed to effectively control urinary schistosomiasis in Lake Malawi. Health clinics must be supplied with praziquantel for distribution. Education centers must emphasize the need for sanitation and clearly state precautions (e.g., avoid swimming between 1000-1500). Additionally, the importance of snail-eating fishes to control the intermediate hosts must be emphasized. If biological controls are to be implemented, alternate food sources (agriculture, aquaculture) must be made available. A true One Health approach must be utilized to effectively control the transmission of schistosomiasis along the lake shores of Lake Malawi