<![CDATA[The Underlying Cause of Death (UCOD) is an essential component in producing accurate mortality data. Incomplete and inaccurate completion of death certificates and UCOD coding may reduce the quality of data used for health statistics, planning, and policy-making. This study aimed to identify factors affecting the quality of UCOD on death certificates. This study used a narrative literature review approach involving 12 articles that met the inclusion criteria. The literature search was conducted through Google Scholar using keywords related to quality, death certificates, UCOD, and health care facilities. The findings showed that UCOD quality was influenced by human resources, methods, and facilities and infrastructure. Human resource factors included limited competence, knowledge, accuracy, and training of health personnel. Method-related factors included the suboptimal implementation of standard operating procedures, mortality coding rules, UCOD reselection, and the use of ICD-10 and the MMDS table. Meanwhile, limitations in facilities and infrastructure included inadequate availability of coding guidelines, supporting facilities, and health information systems. Human resources and methods were identified as the most dominant factors. Incomplete and inaccurate UCOD documentation may reduce the validity of mortality data and affect health program planning and evaluation. Therefore, improving personnel competence through training, implementing standard operating procedures, and consistently applying mortality coding guidelines are necessary to improve UCOD quality.]]>
