From the mid-1980s, we recorded a significant increase in urinary schistosomiasis infection rate and transmission among inhabitants of lakeshore communities in the southern part of Lake Malawi, particularly on Nankumba peninsula in Mangochi District. We suggested that the increase was due to over-fishing, which reduced the density of snail-eating fishes, thereby allowing schistosome intermediate host snails to increase to higher densities. In this article, we collected data to test this hypothesis. The density of both Bulinus nyassanus, the intermediate host of Schistosoma haematobium, and Melanoides spp. was negatively related to density of Trematocranus placodon, the most common of the snail-eating fishes in the shallow water of Lake Malawi. Both these snails are consumed by T. placodon. Transmission of S. haematobium through B. nyassanus only occurs in the southern part of the lake and only at villages where high density of the intermediate host is found relatively close to the shore. Thus, we believe that implementation of an effective fish ban up to 100-m offshore along these specific shorelines in front of villages would allow populations of T. placodon to increase in density and this would lead to reduced density of B. nyassanus and possibly schistosome transmission. To reduce dependence on natural fish populations in the lake and still maintain a source of high quality food, culture of indigenous fishes may be a viable alternative.