Background: Schistosomiasis, which is transmitted by intermediate-host-snails, affects more than 230 million people annually across 78 countries. We showed that rice farming poses an exposure risk of schistosomiasis, leaving families at threat of infection from Schistosoma parasites in northern Senegal. Additionally, rice culturing has high chemical inputs for crop yields and pest control. Here, we tested whether an integrated rice system, co-culturing with native fish, would reduce snails and increase rice productivity. Methods: Over two seasons, we recruited farmers to add native fish (Nile Tilapia and African Bonytongue) to their fields and maintained fields as no-fish controls. We assessed fish growth, rice yield, host-snail abundance, and insects. During the second season, we quantified nutrient levels and used eDNA to validate our malacology sampling and detect Schistosoma parasites. Findings: Fish thrived, growing significantly larger, increasing their market and consumable value. Snail densities were reduced by African Bonytongue (a predator). Rice yield was greater from co-culture fields than controls during both seasons. Soil nutrients that support crop development were increased, and insects were decreased, in co-culture fields. Interpretation: We developed rice-fish co-culturing in Senegal for biocontrol against Schistosomiasis. West Africa consumes about 50% of global rice, driving intensive rice agricultural development, which could increase disease. Our results suggest that rice-fish co-culturing could counter this risk and improve rice farming to have greater and more diversified food production with fewer chemical inputs. eDNA analysis currently underway shows promising ability to more-precisely detect snails and parasites to determine impacts of control innovations.