Porcine cysticercosis (PC) caused by Taenia solium larvae is continuing being important zoonotic disease in many developing countries. It poses a serious public health risk and leads to economic losses to pig production industry. This study was carried out to determine the prevalence and risk factors associated with PC transmission in Nyasa District. To establish the prevalence of PC, a cross-sectional survey was conducted involving 698 pigs by tongue examination, 330 pigs by Ag-ELISA test and 22 pigs by meat inspection. A questionnaire survey was administered to a member of selected households to gather information on pig management and other potential factors that could explain the prevalence of PC in the area. Results showed that 44 pigs were positive by tongue examination (6.3%, 95% C.I. 4.5–8.1%), 110 tested positive for Ag-ELISA (33.3%, 95% C.I. 28.22–38.38%) and meat inspection detected four infected pigs (18.2%, 95% C.I. 2.08–34.32%). Risk factors associated with PC transmission in Nyasa District were free ranging of pigs (p = 0001), sex of pig (p = 0.011), source of pork (p = 0.0001) and outdoor defecation (0.0001). The present findings indicate that PC is endemic in Nyasa District and that free-ranging of pigs in conjunction with limited use of latrines contributes significantly to PC transmission. Therefore, mandatory pig confinement, together with use of latrine/toilets should be considered in controlling PC in Nyasa District.