Objective: To evaluate the prevalence of Schistosoma mansoni-related liver disease in school-age children who live beside the Zambezi River in the Chitokoloki district, North Western Province, Zambia. Methods: Liver ultrasounds of school students from the Chitokoloki day school, grades 1a??12, were performed. Liver patterns, periportal branch wall thickening and portal hypertension were assessed to evaluate the presence of liver fibrosis due to S. mansoni infection. To obtain incidence rates of acute disease, stool specimens were examined from a subgroup for the presence of S. mansoni eggs using the formol detergent sedimentation technique. Results: Of 976 enrolled students, 764 (78.2 ) were examined by ultrasound. Of those, 284 (37.2 ) had findings indicative of periportal fibrosis on ultrasound. Stool specimen were collected from 414 (54 ) students of which six (1.5 ) were positive for S. mansoni eggs. Conclusion: School students living along the Zambezi River, Zambia have a relatively high prevalence of S. mansoni-related liver disease. These findings suggest that all schoolchildren in this area should receive treatment against S. mansoni.