Understanding the factors contributing to the transmission of Taenia solium in sub-Saharan Africa is essential for control. This study aimed to elucidate factors concerning the transmission of porcine cysticercosis in an endemic area. A longitudinal study composed of three cross-sectional surveys (March/April 2012, October/November 2012, and July/August 2013) and a case-control study (July 2014) were carried out in in Mbeya Region, Tanzania. During the cross-sectional surveys venous blood was collected from pigs in 22 villages and analysed for porcine cysticercosis by Ag-ELISA (B158/B60). The case-control study consisted of questionnaire interviews and observational surveys of study households, that were allocated into cases or controls based on porcine cysticercosis presence or absence in the cross-sectional surveys. This resulted in 43 farmers in the case group and 50 farmers in the control group. In each cross-sectional survey between 800–1000 serum samples were collected. This revealed seasonal fluctuation in cysticercosis prevalence from 15% during baseline, to 24% (p<0.001) in the 6-month follow-up, and down to 20% (p=0.053) in the 14-month follow-up. Based on logistic regression porcine cysticercosis could be associated with absence or completely open latrines (p=0.035, OR 5.98, CI: 1.33- 43.02) compared to enclosed latrines, and feeding potato peels to pigs (P=0.007, OR 3.45, CI: 1.43-8.79). Prevalence of porcine cysticercosis fluctuated throughout the seasons, and confined pigs did not have lower sero-prevalence compared to free roaming pigs, supporting transmission from feedstuff. A One Health approach including improved sanitary conditions and pig management is needed to obtain control of T. solium.