An epidemiological survey was conducted between November and December 2007 in 30 randomly selected villages and four slaughterslabs in Mbozi and Mbeya Rural districts, southern Tanzania, to determine the prevalence of porcine cysticercosis. Fifteen villages and three slaughterslabs were from Mbozi and fifteen villages and one slaughterslab were from Mbeya Rural. A total of 600 live pigs (300 in each district) of different sex and age categories were randomly selected from smallholder pig-keeping households and subjected to lingual examination and Antigen-ELISA tests. Postmortem examination was performed in pigs slaughtered in official slaughterslabs and local brew clubs. Questionnaire survey and direct observations were used to investigate potential factors related to transmission of T. solium. The overall prevalence of porcine cysticercosis in Mbozi district was 11.7% (95% CI = 8.5-15.8%) and 32% (95% CI: 27- 37.5%) based on lingual examination and Antigen-ELISA, respectively. In Mbeya Rural district, the prevalences were 6% (95% CI: 3.8-9.3%) and 30.7% (95% CI: 25.8- 36.1%), by lingual examination and Antigen-ELISA tests, respectively. The agreement between the two tests was poor (κ < 40%). There were no significant differences in the prevalence of porcine cysticercosis in different age and sex categories of pigs. None of the 805 pigs slaughtered at official slaughterslabs was infected with cysticercosis based on post-mortem inspection. However, of those slaughtered at local brew clubs, 8.2% (n=437) in Mbozi district and 10.8% (n=74) in Mbeya Rural were positive for cysticercosis. Potential risk factors for porcine cysticercosis in the districts included poor pig management, poor sanitary practices, lack of knowledge on the transmission of T. solium, and lack of meat inspection services. This study recommends educational campaigns in the study communities on the epidemiology of the disease, and subsequent revision of the current regulatory framework for pig trade and pork inspection to safeguard public health and improve livelihoods.