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Objective: To assess the prevalence and intensity of urinary schistosomiasis in school pupils aged five to sixteen years. Setting: Barombi Kotto Health Area, southwest Cameroon. Design: A cross-sectional study. Subjects: Three hundred and forty seven primary school children. Intervention: All children found to be infected were treated with praziquantel (biltricide). Main outcome measures: The study would be able to provide baseline information on the epidemiology of schistosomiasis which is vital for control strategies. Results: The overall prevalence of Schistosoma haematobium in the study areas was 53.6%, with the highest prevalence of 73.9% recorded in Barombi Kotto village. Children resident on Barombi Kotto island were more significantly infected than those on the peripheral mainland (93.3% versus 46.2%, p 0.05) with sex, class or age of the pupils. The mean egg count varied significantly between schools (p < 0.001). Conclusion: Barombi Kotto village was identified as the focus of urinary schistosomiasis, with the highest recorded in children dwelling on the island, the surrounding lake being the main focus of transmission. Focal snail control as an adjunct of chemotherapy and intensive health education for the local population are strongly recommended as a means of reducing the high infection rate in the area.