Effectiveness of zinc-fortified water on zinc intake, status and morbidity in Kenyan pre-school children: a randomised controlled trial

Public Health Nutr. 2018 Oct;21(15):2855-2865. doi: 10.1017/S1368980018001441. Epub 2018 Jun 7.


Objective: Zn deficiency and diarrhoea are prevalent and may coexist in children living in low-resource settings. Recently, a novel approach for delivering Zn via microbiologically treated, Zn-fortified water was shown to be effective in improving Zn status in West African schoolchildren. We assessed the effectiveness of Zn-fortified, microbiologically purified water delivered as a household intervention on Zn intake, status and morbidity in children aged 2-6 years from rural western Kenya.

Design: Randomised controlled trial. Intervention included households assigned to water treatment device with (ZFW) or without (FW) Zn delivery capability SETTING: Rural households in Kisumu, western Kenya.

Subjects: Children aged 2-6 years.

Results: The ZFW group had higher dietary Zn intake compared with the FW group. ZFW contributed 36 and 31 % of daily requirements for absorbable Zn in children aged 2-3 and 4-6 years, respectively, in the ZFW group. Consumption of Zn-fortified water resulted in lower prevalence of reported illness (risk ratio; 95 % CI) in the ZFW group compared with the FW group: for cold with runny nose (0·91; 0·83, 0·99; P=0·034) and abdominal pain (0·70; 0·56, 0·89; P=0·003) in the intention-to-treat analysis and for diarrhoea (0·72; 0·53, 0·96; P=0·025) in the per-protocol analysis. We did not detect an effect of treatment on plasma Zn concentration.

Conclusions: Daily consumption of Zn-fortified, microbiologically treated water results in increased intake of absorbable dietary Zn and may help in preventing childhood infections in pre-school children in rural Africa.

Trial registration: ClinicalTrials.gov NCT02162238.

Keywords: Morbidity; Plasma zinc concentration; Pre-school children; Water fortification; Zinc.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Pain / epidemiology
  • Child
  • Child Nutritional Physiological Phenomena
  • Child, Preschool
  • Common Cold / epidemiology
  • Diarrhea / epidemiology
  • Drinking Water / administration & dosage*
  • Drinking Water / chemistry
  • Female
  • Food, Fortified / analysis*
  • Humans
  • Intention to Treat Analysis
  • Kenya / epidemiology
  • Male
  • Nutritional Status / drug effects*
  • Prevalence
  • Recommended Dietary Allowances
  • Rural Population
  • Sinusitis / epidemiology
  • Trace Elements / administration & dosage*
  • Trace Elements / blood
  • Zinc / administration & dosage*
  • Zinc / blood


  • Drinking Water
  • Trace Elements
  • Zinc

Associated data

  • ClinicalTrials.gov/NCT02162238