Objective  To examine the status of household sanitation, prevalence and impact factors of diarrhea in small children in rural ethnic minority regions of central and western China for providing evidences to child diarrhea prevention.

  Methods  Using probability-proportional-to-size sampling, we recruited 1 355 children aged ≤ 5 years in 90 villages in Henan province (Henan), Sichuan Yi Autonomous Prefecture (Sichuan) and Tibet Autonomous Region (Tibet) and conducted a face-to-face questionnaire survey among the caregivers of the children during August – October 2016.

  Results  Valid information were collected from caregivers of 1 348 children averagely aged 22.34 ± 15.56 months. The overall two-week prevalence rate of diarrhea was 17.58% for all the children and the two-week prevalence rate for the children in Henan, Sichuan, and Tibet were 6.63%, 25.42%, and 15.17%, respectively, with a significant difference (χ² = 71.096, P < 0.001). The diarrhea prevalence rate differed significantly by daily care and household sanitation among the children of different nationalities and living in various regions (P < 0.05). Multivariate logistic regression analysis revealed following main risk factors for child diarrhea prevalence: aged < 24 months (0 – 5 months: odds ratio OR = 4.096, 95% confidence interval 95% CI: 1.140 – 14.721; 6 – 12 months: OR = 4.875, 95% CI: 1.389 – 17.110; 12 – 23 months: OR = 6.969, 95% CI: 2.059 – 23.583); consuming unboiled drinking water (OR = 1.678, 95% CI = 1.024 – 2.749); and consuming domestic water from an unprotected water source (OR = 1.786, 95% CI: 1.067 – 2.991).

  Conclusion  Among the small children in rural regions of central and western China, diarrhea is prevalent and there are obvious disparities in diarrhea prevalence among the children of different nationalities and living in various regions. Household hygienic condition of drinking water and domestic water need to be improved for the prevention of diarrhea in the children, especially in those less than two years old.