Objective  To analyze the status quo and regional variations of environmental hygiene and disease prevalence in rural areas of Shandong province and to provide evidences for developing targeted interventions and control measures.

  Methods  We conducted surveys at 500 villages in 25 counties or prefectures selected using stratified random sampling across Shandong province during 2015 – 2017. The surveys included relevant information collection, field study, soil sample collection for every villages selected, interviews with family members of 2 500 households in the villages surveyed using a unified questionnaire, and laboratory test to detect heavy metal and ascaris eggs in the soil samples.

  Results  The coverage rate of harmless sanitary toilet was 53.34% for all the counties surveyed and the rate differed significantly among the counties with different geographical locations (P < 0.05). The regional coverage rate of harmless sanitary toilet was positively correlated with regional annual net income per capita (r = 0.997, P = 0.045). During the 3-year period among the residents in the 500 villages, the crude mortality rate was 563/100 000 and the major causes of the mortality were heart diseases, malignant tumors and cerebrovascular diseases. For all the residents in the 500 villages, the mean coverage rate of garbage and sewage treatment plant was 58.50% and 40.80% and the rate was significantly different for the residents living in eastern, central and western areas of the province (P < 0.05). The detection rate of ascaris eggs was 17.20% for all soil samples and there was no significant difference in the detection rate among the samples collected in different regions (P = 0.31); but the regional detection rate of ascaris eggs was inversely correlated significantly with the regional annual net income per capita (r = – 0.998, P = 0.04). The detection rate of live ascaris eggs was 5.20% for all the soil samples and there was a significant regional difference in the rate (P < 0.05). The qualified rate of heavy metal concentration for all soil samples was 87.40%, with a significant regional difference (P < 0.05); the qualified rate of cadmium concentration was 89.00%, also with a significant regional difference (P < 0.05).

  Conclusion  Environmental hygiene conditions are significantly associated with disease prevalence in rural areas of Shandong province. The detection rate of live ascaris eggs in soil samples is relatively higher for western rural region and soil cadmium pollution is more serious in the eastern rural region of the province. The results suggest that region specific interventions and control measures should be implemented.