Cryptic crossword clue
Old fellow’s last letterafter onset of malaria to some

The most common and most likely answer to this crossword clue is the 4 letter word MZEE

M
Z
E
E

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The straight part
We know that "Old fellow" is the straight/definition part of the clue. The straight part is often a synonym or definition, in this case old fellow = mzee.
The cryptic/wordplay part
In cryptic crossword there's often an wordplay/cryptic part as well.
This part involves a more complex hint, such as an anagram, homophone, hidden word, etc.
Sadly, We don't have an explanation for this specific crossword clue yet.

What does MZEE mean?

MZEE noun
  1. An elder (old person).

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