Abstract
Owning pets offers various potential health benefits; however, it can be associated with gastrointestinal illnesses due to poor food safety knowledge and practices. This study aimed to evaluate the level of food safety knowledge and practices among pet owners in Lebanon, exploring the association between their knowledge/practices and socio-demographic characteristics. The participants included 300 pet owners, representing various genders, ages, educational levels, educational backgrounds, and incomes. They completed a questionnaire of 72 food handling practices and knowledge questions related to preparation, cross-contamination, storage and hygiene. In parallel, 300 non-pet owners with comparable sociodemographic characteristics to pet owners (control group) completed the questionnaire. On average, food safety knowledge scores were 62.1 ± 14.9% and 58.7 ± 15.5% among pet and non-pet owners, respectively, and the difference was significant (p = 0.05). On the other hand, mean food safety practice scores were 41.3 ± 14.8% and 40.4 ± 15.3% among pet and non-pet owners, respectively, and the difference was not significant (p = 0.41). In the food safety knowledge part, non-pet owners who were young, high income, university graduate, and from health-related majors scored significantly (p < 0.05) higher, while among pet-owners, only participants with a university degree and from health-related majors scored significantly (p < 0.05) higher, in terms of knowledge. On the other hand, In the food safety practices part, non-pet owners who were young, high income, and university graduates scored significantly (p < 0.05) higher, while among pet-owners, only young and high-income participants scored significantly (p < 0.05) higher. These results highlight the need for ongoing educational initiatives to improve food safety practices among both pet owners in Lebanon. The study suggests that targeted educational programs should be developed, considering specific socio-demographic characteristics, to enhance overall food safety awareness and practices among the population.
Keywords: Food safety knowledge, Practices, Pet owner, Lebanon, Socio-demographic factors, Questionnaire, Education program
Subject terms: Psychology and behaviour, Diseases, Gastrointestinal diseases
Introduction
Numerous research studies dating back to the 1980s have explored the impact of pet ownership on human health, presenting both positive and negative effects1–7. Owning pets offers various potential health benefits, such as increased opportunities for exercise, outdoor activities, socialization, and enhanced ability to cope with loneliness and depression8.
On the other hand, negative effects associated with pet ownership have also been documented, including gastrointestinal, respiratory, and skin or eye symptoms9. Some pet owners exhibit poor personal hygiene practices after interacting with their pets or other areas within pet environments, such as food, toys, or bedding, leading to illness, especially if hands are not washed before handling human food preparation8. The CDC reports outbreaks of human infections linked to contact with animals and animal products in the United States, including salmonellosis associated with guinea pigs (2018), live poultry (2012, 2014, 2015, 2016, 2017, and 2018), turtles (2012, 2013, 2015, and 2017), pet store puppies (2017), pet bearded dragons (2014), and dry pet food and treats (2007, 2012, and 2019)8,10,11. Examples of additional possible zoonotic diseases encompass toxoplasmosis, giardiasis, babesiosis, American trypanosomiasis, and leishmaniasis12. While symptoms for certain diseases are mild, others can lead to more severe illness and even death8. Toxoplasmosis contracted during a woman’s pregnancy can result in transmission to the fetus, leading to various severe consequences, ranging from miscarriage to intellectual and developmental disabilities, microcephaly, or other manifestations13. Pets can carry microorganisms that may cause illness in humans, even if the pet appears healthy8. Typically, healthy individuals are safeguarded by their immune system, proper nutrition, sanitation, and personal hygiene12. However, individuals with compromised immune systems, including an increasing number of diabetic and/or obese individuals, as well as those over the age of 65 and those under 5 years old, face a higher risk of developing zoonoses. The CDC projects that 6 out of 10 known infectious diseases in people are transmitted from animals, and 3 out of 4 new or emerging infectious diseases in people also originate from animals8. Indirect contact can also lead to transmission by coming into contact with areas where animals live or objects they may have touched8. Understanding the risk of disease-causing microorganisms spread through animal contact is considered crucial as it reliably predicts hand washing behaviors14. Handwashing plays a crucial role in safeguarding against zoonotic diseases8. Proper handwashing is advised after activities like touching, playing, or feeding pets, handling pet food, pet habitats, or equipment such as cages or toys, cleaning up after pets, and leaving areas where animals reside (coops, barns, or stalls), even if there was no direct contact with an animal. Handwashing is also emphasized before eating, drinking, or engaging in food and drink preparation8. Additionally, good “pet hygiene” practices involve keeping pets and their supplies away from the kitchen and disinfecting pet habitats and supplies outdoors when feasible.
Several studies have explored aspects of the connection between pets and food handling15,16. In Lebanon, Hassan and Dimassi17,18 investigated the food safety knowledge and practices among university students and food handlers in households, respectively. In addition, Dimassi et al.19 assessed food hygiene related knowledge and practices during the COVID-19 pandemic. However, no study in Lebanon and the Arab region investigated food safety knowledge and practices among pet owners. Our study aims to assess the food safety knowledge among pet owners and to examine the correlation between pet ownership and adherence to safe food handling practices, considering sociodemographic variables (such as gender, age, education, household income, and household size), as prior research has suggested associations between these factors and food handling behaviors16,20–22. This will provide practical guidance for tailoring targeted educational programs for pet owners.
Materials and methods
Study population
Using a cross-sectional observational design, data was collected via a short 20 min, face to face interviews. A convenient sample of 300 pet owners and 300 non-pet owners was recruited in the study. The completion of the questionnaire was voluntary and anonymous, and no extra credit was given. Incomplete questionnaires were excluded automatically. Six hundred valid questionnaires were completed.
Questionnaire
A questionnaire, consisting of 7 sections and comprising 72 questions, was developed based on established and reliable instruments17,18,22–25. Some questions underwent minor adjustments in language and key terminology to ensure cultural specificity. The survey was translated into Arabic by a certified translator, and a back translation to English was conducted to validate the accuracy of the translation. Both versions underwent a pilot test to evaluate clarity and determine the average time required for completion. The first section of the questionnaire (11 questions) was concerned about general demographic characteristics of the participants (age, gender, educational background, economic status and household size). The second Sect. (5 questions) focused on the risk perception of the participant, which included the perception towards food poising through homemade food, food prepared outside home, and how likely the consumer might become sick due to ingesting various foods, if they were contaminated with microorganisms. The third Sect. (32 questions) covered the food handling practices, such as frequency of handwashing, food preparation methods, cleaning and sanitation. The fourth Sect. (4 questions) assessed the familiarity of participants with various pathogenic microorganisms (Salmonella, Listeria, Campylobacter, E. Coli and Toxoplasma) and personal vulnerability when exposed to favorable growth conditions of microorganisms. The fifth Sect. (4 questions) was about use of thermometers. The sixth Sect. (6 questions) focused on food consumption habits of various high-risk foods. The seventh and final Sect. (10 questions) assessed the food safety knowledge of the participants through True and False statements. Ethical approvals were obtained from the Institutional Review Board at the Lebanese American University. Informed consent was obtained from all participants. All methods were performed in accordance with the relevant guidelines and regulations.
Statistical analysis
The statistical software SPSS version 18 was employed to perform all statistical analyses. The demographic characteristics served as the independent variables, while the dependent variables encompassed food safety and handling knowledge and practices outcomes derived from the questionnaire. Each multiple-choice item was allotted a score of 1 point for a correct answer and 0 points for incorrect answers. The mean sum of correct responses in each section was compared using Student t-test and Analysis of Variance (ANOVA), considering factors such as gender, age, major of study, educational level, and income. A significance level of 0.05 was applied17,18.
Results
A total of 600 questionnaires from 300 pet owners and 300 non-pet owners (control) were included in the study. Of the respondents, among pet owners, 57.3% were women, 80.7% below 36 years old, 4.3% having at least one person less than 5 years old at home, 31.3% having at least one person above 60 years old at home, 69.3% holders of a university degree, 26.4% of a heath educational background, 3.7% pregnant, 34.7% income with less than $1500. Almost similar characteristics were among the control group (non-pet owners) (Table 1).
Table 1.
Demographic characteristics of the sample (n = 600).
| Demographics | Pet owners | Non-pet owners | ||
|---|---|---|---|---|
| n | % | n | % | |
| Gender | ||||
| Male | 128 | 42.7 | 123 | 41.0 |
| Female | 172 | 57.3 | 177 | 59.0 |
| Age | ||||
| 18–25 | 167 | 55.7 | 166 | 55.3 |
| 26–35 | 75 | 25.0 | 77 | 25.7 |
| 36–49 | 28 | 9.3 | 28 | 9.3 |
| 50 and above | 30 | 10.0 | 29 | 9.7 |
| # of children (less than 5 years at home) | ||||
| None | 287 | 95.7 | 284 | 94.7 |
| At least 1 | 13 | 4.3 | 16 | 5.3 |
| # of elderly (above 60 years) | ||||
| None | 206 | 68.7 | 204 | 68.0 |
| At least 1 | 94 | 31.3 | 96 | 32.0 |
| Education | ||||
| Less than high school degree | 11 | 3.7 | 11 | 3.7 |
| High school graduate | 79 | 26.3 | 78 | 26.0 |
| University graduate (13–15 years) | 208 | 69.3 | 211 | 70.3 |
| Major of Study in University | ||||
| Natural sciences (bio, chem, phy, maths) | 16 | 7.7 | 20 | 9.2 |
| Nutrition/Food Sc./Agriculture | 11 | 5.3 | 12 | 5.5 |
| Health and medical sciences | 28 | 13.5 | 25 | 11.5 |
| Engineering/IT | 35 | 16.8 | 38 | 17.5 |
| Business/economics | 53 | 25.5 | 51 | 23.5 |
| Social sciences (socio, psych, pol sc, edu) | 31 | 14.9 | 30 | 13.8 |
| Humanities (eng, translation, history) | 34 | 16.3 | 35 | 16.1 |
| Pregnant | ||||
| No | 286 | 95.3 | 284 | 94.7 |
| Yes | 11 | 3.7 | 14 | 4.7 |
| Monthly income | ||||
| No income | 11 | 3.7 | 12 | 4.0 |
| Less than USD500 | 36 | 12.0 | 35 | 11.7 |
| USD501-1500 | 57 | 19.0 | 55 | 18.3 |
| USD1501-2500 | 41 | 13.7 | 42 | 14.0 |
| USD2501-4000 | 40 | 13.3 | 41 | 13.7 |
| More than USD4000 | 50 | 16.7 | 47 | 15.7 |
| Refuse to answer | 65 | 21.7 | 68 | 22.7 |
The overall food safety knowledge score was the sum of correct responses for each participant on the ten questions (Table 2). Its mean value was 72.1% (Standard Deviation SD 14.9) among pet owners, and 68.7% (SD 15.5) among non-pet owners (Table 3). Among the 10 knowledge questions (Table 2), poor response (below 50%) was reported for the recommended freezer temperature (Q4) and internal cooking temperature for burger (Q8). Correct answers on 7 out of 10 questions was more evident among pet owners, reflecting their higher knowledge score compared to the control group.
Table 2.
Answers to the food safety knowledge questions.
| Question and respective answer choices | Pet Owners n (%) |
Non-Pet Owners n (%) |
|---|---|---|
| 1. The best scenario for cleaning kitchen counters is: soap, then water, then sanitizer | ||
| True* | 253 (84.3)* | 261 (87)* |
| False | 47(15.7) | 39 (13) |
| 2. While washing your hands, it is enough to rub them for 20 s | ||
| True* | 206 (68.7)* | 200 (66.7)* |
| False | 94 (31.3) | 100 (33.3) |
| 3. Freezing kills harmful germs in food | ||
| True | 71 (23.7) | 81 (27.0) |
| False* | 229 (76.3)* | 219 (73.0)* |
| 4. (− 8 °C) is the recommended temperature for freezers | ||
| True | 176 (58.7) | 197 (65.7) |
| False* | 124 (41.3)* | 102 (34.0)* |
| 5. (+ 4) is the recommended temperature for fridges | ||
| True* | 220 (73.3)* | 230 (76.7)* |
| False | 80 (26.7) | 69 (23.0) |
| 6. Fruit salad does not need to be refrigerated | ||
| True | 42 (14.0) | 53 (17.7) |
| False* | 258 (83.3)* | 247 (82.3)* |
| 7. Freezing a food that has salmonella bacteria in it for 3 days made it safe to consume | ||
| True | 48 (16.0) | 61 (20.3) |
| False* | 250 (84.0)* | 237 (79.0)* |
| 8. For a burger to be safe to eat, it needs to be cooked until its internal temperature reaches 71 °C | ||
| True | 204 (68.0) | 189 (63.0) |
| False* | 93 (31.0)* | 110 (36.7)* |
| 9. The microorganisms that cause most of food-borne illnesses are viruses | ||
| True | 119 (39.7) | 129 (43.0) |
| False* | 181 (60.3)* | 168 (56.0)* |
| 10. Teenagers are LEAST likely to get food poisoning | ||
| True | 60 (20.0) | 93 (31.0) |
| False* | 239 (79.7)* | 207 (69.0)* |
*Correct answer.
Table 3.
Mean scores of food safety knowledge and practices among pet and non-pet owners.
| Pet owners | Non-pet owners | p-value | |||
|---|---|---|---|---|---|
| Mean score (%) | SD | Mean score (%) | SD | ||
| Food safety knowledge | 62.1 | 14.9 | 58.7 | 15.5 | 0.013 |
| Food safety practices | 41.4 | 14.8 | 40.4 | 15.3 | 0.197 |
The overall food-handling practices score was the sum of correct responses in the “food handling practices” section for each participant and its mean value was 41.3% (SD 14.8) among pet owners, and 40.4% (SD 15.3) among non-pet owners (Table 3). The significance levels for each variable are presented in Table 4 for food safety knowledge and Table 5 for food safety practices. In the food safety knowledge part (Table 4), females scored higher than males among pet and non-pet owners, but the difference was not significant. Also, the younger the age group was, the higher the knowledge score got, but the difference was only significant (p < 0.001) among non-pet owners. Having at least one child below 5 years old, one elderly above 60 years old, or a pregnant at home resulted in higher knowledge score for both pet and non-pet owners, but the difference was not significant. Furthermore, the higher the income was, the higher, in general, the knowledge score was for both groups, but the difference was only significant (p = 0.02) among non-pet owners. Higher educational level and holding a health-related degree implied higher knowledge score in both groups, and the difference was significant (p < 0.001).
Table 4.
Relations between demographic characteristics and knowledge score among pet and non-pet owners.
| Pet owners | Non-pet owners | |||
|---|---|---|---|---|
| Mean score (%) | SD | Mean score (%) | SD | |
| Gender | ||||
| Male | 72.19 | 14.90 | 67.15 | 15.55 |
| Female | 72.09 | 14.88 | 69.72 | 15.43 |
| P value | 0.96 | 0.16 | ||
| Age | ||||
| 18–25 | 74.40 | 14.49 | 71.38 | 14.37 |
| 26–35 | 72.40 | 13.68 | 70.00 | 14.11 |
| 36–49 | 65.36 | 17.95 | 64.46 | 17.47 |
| 50 and above | 70.00 | 12.91 | 50.00 | 21.38 |
| P value | 0.10 | < 0.001 | ||
| # of Children under 5 at home | ||||
| None | 72.23 | 14.93 | 68.21 | 15.61 |
| At least one | 72.50 | 10.55 | 71.43 | 14.91 |
| P value | 0.95 | 0.46 | ||
| # of Elderly (above 60 years) | ||||
| None | 72.09 | 14.00 | 68.46 | 14.85 |
| At least one | 72.58 | 16.41 | 69.02 | 16.60 |
| P value | 0.79 | 0.76 | ||
| Monthly income | ||||
| Less than USD500 | 70.28 | 16.82 | 66.14 | 15.69 |
| USD501-1500 | 71.95 | 15.19 | 68.14 | 15.54 |
| USD1501-2500 | 73.68 | 12.09 | 66.39 | 13.68 |
| USD2501-4000 | 76.50 | 14.24 | 67.56 | 14.37 |
| More than USD4000 | 73.20 | 14.06 | 72.08 | 13.20 |
| P value | 0.11 | 0.02 | ||
| Educational level | ||||
| Less than high school degree | 54.55 | 10.36 | 56.67 | 14.35 |
| High school graduate | 67.97 | 14.88 | 66.90 | 14.98 |
| University graduate (13–15 years) | 74.52 | 14.13 | 70.33 | 14.77 |
| P value | < 0.001 | < 0.001 | ||
| Field of study | ||||
| Natural sciences (bio, chem, phy, maths) | 78.13 | 15.15 | 73.48 | 14.02 |
| Nutrition/Food Sc./Agriculture | 89.09 | 8.31 | 87.50 | 13.42 |
| Health and medical sciences | 76.07 | 14.23 | 77.27 | 13.16 |
| Engineering/IT | 73.43 | 14.34 | 66.89 | 14.11 |
| Business/economics | 72.64 | 13.75 | 65.45 | 13.20 |
| Social sciences (socio, psych, pol sc, edu) | 74.84 | 13.38 | 65.77 | 13.91 |
| Humanities (eng, translation, history) | 70.00 | 13.97 | 70.24 | 13.32 |
| P value | 0.01 | < 0.001 | ||
| Pregnant? | ||||
| Yes | 72.73 | 13.48 | 69.04 | 16.78 |
| No | 72.31 | 14.85 | 62.35 | 15.43 |
| P value | 0.50 | 0.22 | ||
Table 5.
Relations between demographic characteristics and practices score among pet and non-pet owners.
| Pet owners | Non-pet owners | |||
|---|---|---|---|---|
| Mean | SD | Mean | SD | |
| Gender | ||||
| Male | 40.48 | 15.56 | 38.64 | 16.25 |
| Female | 42.07 | 14.14 | 41.60 | 14.57 |
| P value | 0.36 | 0.10 | ||
| Age | ||||
| 18–25 | 44.12 | 16.00 | 45.67 | 16.62 |
| 26–35 | 41.21 | 13.77 | 38.86 | 13.46 |
| 36–49 | 35.38 | 9.40 | 36.00 | 12.32 |
| 50 and above | 32.47 | 6.85 | 32.16 | 12.10 |
| P value | 0.01 | < 0.001 | ||
| # of children under 5 at home | ||||
| None | 41.38 | 14.84 | 40.20 | 15.55 |
| At least one | 41.29 | 14.04 | 41.73 | 14.11 |
| P value | 0.98 | 0.71 | ||
| # of elderly (above 60 years) | ||||
| None | 42.30 | 14.96 | 40.45 | 14.92 |
| At least one | 39.35 | 14.24 | 40.27 | 16.06 |
| P value | 0.11 | 0.92 | ||
| Monthly income | ||||
| Less than USD500 | 36.62 | 9.28 | 36.37 | 13.83 |
| USD501-1500 | 36.20 | 11.07 | 35.49 | 12.24 |
| USD1501-2500 | 42.24 | 15.72 | 43.30 | 15.52 |
| USD2501-4000 | 43.27 | 14.43 | 47.04 | 14.61 |
| More than USD4000 | 54.89 | 16.02 | 48.98 | 15.48 |
| P value | < 0.001 | < 0.001 | ||
| Educational level | ||||
| Less than high school degree | 31.41 | 9.42 | 29.82 | 10.37 |
| High school graduate | 41.67 | 16.18 | 40.25 | 17.93 |
| University graduate (13–15 years) | 42.23 | 14.32 | 41.34 | 14.25 |
| P value | 0.18 | 0.01 | ||
| Field of study | ||||
| Natural sciences (bio, chem, phy, maths) | 46.88 | 17.70 | 42.56 | 15.62 |
| Nutrition/Food Sc./Agriculture | 42.64 | 9.32 | 43.00 | 9.12 |
| Health and medical sciences | 44.34 | 12.98 | 43.12 | 12.11 |
| Engineering/IT | 40.00 | 12.80 | 40.35 | 14.24 |
| Business/economics | 37.82 | 16.07 | 42.70 | 15.11 |
| Social sciences (socio, psych, pol sc, edu) | 41.79 | 12.88 | 40.19 | 15.18 |
| Humanities (eng, translation, history) | 36.36 | 15.19 | 38.16 | 14.55 |
| P value | 0.22 | 0.86 | ||
| Pregnant? | ||||
| Yes | 41.53 | 5.78 | 40.47 | 10.03 |
| No | 37.60 | 15.05 | 39.01 | 15.67 |
| P value | 0.26 | 0.83 | ||
In the food safety practices part (Table 5), females scored higher than males among pet and non-pet owners, but the difference was not significant. Also, the younger the age group was, the higher the knowledge score got, and the difference was significant (p < 0.001) in both groups. Having at least one child below 5 years old, one elderly above 60 years old, or a pregnant at home resulted in higher practices score for both pet and non-pet owners, but the difference was not significant. Furthermore, the higher the income was, the higher, in general, the practices score was for both groups, but the difference was significant (p < 0.001) in both groups. Higher educational level implied higher practices score in both groups, and the difference was only significant (p < 0.001) among non-pet owners. Holding a university degree related to health sciences resulted in higher practices score in both groups, and the difference was not significant.
Discussion
Our research provides insights into the self-reported food-handling knowledge and practices among pet owners in Lebanon. The feedback from participants indicated a limited understanding of food safety (62.1%) and subpar adherence to proper food-handling practices (41.4%). Compared to the control group (non-pet owners), food safety knowledge and practices scores were lower (58.7% and 40.4%, respectively), and the difference was significant (p = 0.013) in the knowledge section only. Poor food safety awareness among adults was also reported in previous studies23–28. In Lebanon, Hassan and Dimassi17 reported a mean food-safety knowledge and practices scores of 53.6% and 44.8%, respectively among university students, which is comparable to our finding for the control non-pet owner group (58.7% and 40.4%, respectively).
Participants from health-related university backgrounds (Biology, Nutrition, Pharmacy Chemistry …) scored significantly higher in terms of food safety knowledge and practices, among both groups. This could be due to the fact that modules and courses relevant to food safety, hygiene and microbiology are present in the curricula of health-related majors24. Females in both groups scored better than males in both knowledge and practices, but the difference was not significant. This may be attributed to the traditional role in Lebanon where females typically take responsibility for kitchen hygiene and cleaning. This aligns with the results of prior studies, where female students consistently demonstrated better performance than their male counterparts18,29.
Participants having at least one vulnerable person at home (child below 5 years, adult above 60 years, or pregnant) scored higher in terms of food safety knowledge and practices, among both groups, but the difference was not significant. This could be attributed to the fact that having a vulnerable family member implies more stringent hygiene practices to avoid the associated foodborne illnesses. This aligns with the finding of Ma et al.22. Furthermore, the higher the income was, the higher scores were reported for both knowledge and practices sections, but the different was significant (p < 0.05), except for knowledge score among pet owners (p = 0.11). This can be due to the fact that high income is usually associated with high education, implying more knowledge and awareness about food safety, and the financial capability to have all needed resources for effective good hygiene practices18.
Literature on food safety knowledge and practices among pet owners is scarce. Ma et al.22 reported that pet ownership was significantly associated with overall food safety practices, and, more specifically, with better hand washing behaviors, kitchen cleaning, and use of a food thermometer, as well as a greater awareness of foodborne pathogens. which goes in line with our findings.
Conclusion
Despite limitations in the study design, such as the absence of a true random sample in the sampling process and reliance on self-reported data, which introduces the potential for mono-method bias, our research provided valuable insights into the state of food safety knowledge and practices among pet owners in Lebanon. The noteworthy lack of awareness about food safety, as evidenced by the low practice scores reported by participants, poses an immediate risk of increased susceptibility to food poisoning. To address these issues, it is essential to implement targeted educational initiatives. Programs specifically tailored to older adults should be developed to address their unique needs and ensure they understand proper food safety practices. Campaigns aimed at increasing awareness among male pet owners are also necessary, as they may have lower food safety knowledge and practices. Providing accessible and affordable food safety education to low-income individuals will ensure they have the necessary resources and knowledge to handle food safely. Additionally, creating educational materials that are easily understandable for individuals without a university degree, using clear and simple language, is crucial. These educational efforts should be disseminated through diverse media channels, such as social media, television, radio, and community workshops, to reach a broad audience. Developing engaging and interactive content, like videos, infographics, and live demonstrations, can capture the attention of different demographic groups and enhance learning. By focusing on these targeted educational efforts and utilizing diverse media channels, we can effectively address the gaps in food safety knowledge and reduce the risk of food poisoning among pet owners in Lebanon.
Author contributions
H.H.: methodology, data curation, conceptualization, project administration, resources, writing (original draft preparation). H.D.: formal analysis, writing (reviewing and editing). A.F.: investigation, writing (original draft preparation). K.A.A.: investigation, writing (original draft preparation). H.B.H.: investigation, writing (original draft preparation). R.H.: investigation, writing (original draft preparation). S.K.: investigation, writing (original draft preparation). M.S.: methodology, conceptualization, validation, writing (reviewing and editing).
Data availability
All data generated or analysed during this study are included in this published article.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Hussein F. Hassan, Email: Hussein.hassan@lau.edu.lb
Mireille Serhan, Email: Mireille.serhan@balamand.edu.lb.
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Data Availability Statement
All data generated or analysed during this study are included in this published article.