Municipalities play an imperative role in public service delivery, especially in developing countries where there are pressing challenges on governance, accountability, and resource constraints. Audit outcomes serve as a tool for evaluating the financial health and governance efficacy of municipalities. While existing literature has contributed to the understanding of factors influencing audit outcomes, persistent challenges in achieving clean audit opinions within municipalities highlight the need for further investigation. This paper seeks to address this gap by offering a more comprehensive analysis of the determinants affecting audit outcomes in municipal financial statements. This study conducts a systematic literature review to explore the drivers of municipal audit outcomes. This review covers 50 articles retrieved from Scopus and Web of Science, audit reports, and policy documents published between 2000 and 2024. Findings revealed that there has been a significant increase in publications addressing accountability in local government since 2020, possibly driven by growing public scrutiny and governance challenges. Though there has been a rise, more robust and diverse research is required. Researcher can explore areas such as audit timeliness, performance management, and consequence management in municipal context. Evidence suggests that audit timeliness is a key determinant of audit opinion, with delayed reporting often associated with adverse or qualified audit outcomes. This review contributes by providing a summary of fragmented findings on audit outcomes in municipalities, identifying key determinants, and highlighting areas for future empirical research.