Highlights • A smartphone based optical spectrum detection device with novel lens-less design. • High accuracy and high sensitivity for IL-6 biomarker detection and spiked organophosphorus poisoning sample diagnosis. • Assessment of the device for organophosphorus poisoning with blood samples from agricultural workers. • The results showed good agreement with that of conventional laboratory equipment. Abstract In this work, we present an ultra-low-cost smartphone device for in situ quantification of OP poisoning severity. The performance of the lens-less smartphone spectrum apparatus (LeSSA) is evaluated using standard human Interleukin-6 (IL-6) immunoassay kits. Upon dose-response curve fitting, LeSSA demonstrates an accuracy of 99.5%. The limit of detection (LOD) of LeSSA was evaluated through comparison of 6.4 pg/ml with standard laboratory grade UV–vis spectrophotometer at 5.5 pg/ml. Evaluating the capacity of LeSSA in spike solution by combining plasma cholinesterase (PChE) and human plasma shows consistency at agreement of 97.6% between LeSSA and the laboratory instrument. For application demonstration, the activity of PChE for 24 agricultural workers' plasma samples was measured with LeSSA, showing exceptional agreement (r2 = 0.92) with the laboratory instrument reference. In addition to near laboratory grade accuracy, the total manufacturing cost of LeSSA is only $20 USD highlighting it's affordability. With LeSSA, clinicians can evaluate OP poisoning severity without the need to transport patient samples to facilities at far distances. Utilizing LeSSA, immediate results can be used for administration of appropriate treatment. [ABSTRACT FROM AUTHOR]