Objective: This study investigates whether or not households in Nigeria are aware and guided by the national treatment policy in their health seeking behavior and assesses the impacts of the treatment choices of the households on the prevalence of malaria, especially in the light of spatial variations in malaria prevalence in the study area. Methods: Using a structured questionnaire administered on 1,084 household heads randomly selected from 15 residential neighborhoods of contrasting residential environmental quality, defined largely by income and education in Ibadan, data on knowledge of treatment policies, treatment choices, whether or not the policies influenced their treatment choices and frequency of treating episodes of malaria in the households annually were elicited. The data were analyzed using proportion, percentages, one-way analysis of variance, Chi-square, and Spearman Rank Correlation statistical techniques. Findings: More than 70% of the respondents in the high and medium density residential neighborhoods were not aware of any treatment policy, nearly 43% of the respondents treated malaria in their households through self-medication while about 27.8% of those who patronized health facilities received prescription notes rather than drugs. Income affected treatment choices (χ2 = 22.892, P < 0.001) just as literacy did (χ2 = 87.530, P < 0.001). The correlation analyses also show that treatment choices affected the frequency of treating malaria and number of days spent treating an episode of malaria. Conclusion: The study concluded that poor knowledge of and gaps in the treatment policy contributed to the high prevalence of malaria in Nigeria.